三种微创术式治疗复杂性输尿管上段结石的疗效分析

目的 探讨输尿管软镜钬激光碎石(FURS)、微创经皮肾取石术(MPCNL)及腹腔镜输尿管切开取石(LU)三组微创术治疗复杂性输尿管上段结石的疗效.方法 回顾性分析本院2010年1月至2014年1月收治复杂性输尿管上段结石患者285例,根据所行术式,分为三组,FURS组58例,MPCNL组109例及LU组118例,观察三组患者的手术时间、术后住院时间、住院费用、术后D-J管留置时间、术后3d净石率、术后1个月净石率、术后辅助体外冲击波(ESWL)治疗例数、术后并发症发生率.结果 三组患者复杂性输尿管上段结石术后3d的净石率分别为98.3％(FURS组)、88.1％(MPCNL组)、94.4％(LU组),其中MPCNL组术后3d的净石率较低,明显低于FURS组(P＜0.05),而三组患者的术后1个月净石率比较无明显差异(P＞0.05);与FURS组患者相比,MPCNL组及LU组患者的手术时间、住院时间明显增加,住院费用明显较少,术后并发症发生率较高,差异有统计学意义(P＜0.05);与MPCNL组患者相比,LU组患者手术时间(69.32±6.05) min较短,术后需ESWL辅助处理率(1.7％)更小,术后并发症发生率(3.6％)较低;而三组患者在术后D-J留置时间方面无明显差异(P＞0.05).结论 复杂性输尿管上段结石的治疗可根据患者的综合情况,选择合适而理想的个体化微创治疗方案,而输尿管软镜钬激光碎石治疗具有碎石效率高、安全的优势,值得临床进一步推广应用.

Analysis of the curative effect of complex ureteral calculi by three minimally invasive surgical treatment

Objectives To determine the curative effect of complex ureteral calculi by three minimally invasive surgical treatment.Methods A retrospective analysis of clinical data of 285 cases with the complex ureteral calculi in our hospital from January 2010 to January 2014.According to surgical method,and cases were divided into three groups,58 cases in the FURS group,118 cases and 109 cases were in the MPCNL group and the LU group respectively.The operative time,postoperative hospital stay,hospital costs,postoperative indwelling D-J tube time,stone-free rate after three days net,stone-free rate after one month,the number of cases of postoperative adjuvant extracorporeal shock wave(ESWL) treatment,the incidence of postoperative complications were observed among the three groups.Results The stone-free rate of patients on the complex ureteral calculi segment net after three days among the three groups were 98.3％ (FURS group),88.1％ (MPCNL group),94.4％ (LU group) respectively.The stone-free rate of patients in the MPCNL group after three days significantly lower than FURS group (P ＜ 0.05),while the three groups of patients after one month of net stone rate were no significant difference (P ＞ 0.05).Patients in the MPCNL and LU groups,the operative time,length of hospital stay was significantly increased compared with patients in the FURS group,while hospital costs was significantly less,and with a higher incidence of postoperative complications,the difference was statistically significant(P ＜ 0.05).To compare with patients in the MPCNL group,patients in the LU group with shorter operative time (69.32 ± 6.05) min and smaller auxiliary ESWL treatment rate (1.7％),lower complication rate (3.6％).However,patients among the three groups in the postoperative indwelling D-J tube time had no significant difference (P ＞ 0.05).Conclusions We should select the appropriate and desirable individual minimally invasive treatment options for complex ureteral calculi according to the patient ’s overall situation.Moreover,flexible ureteroscope holmium laser lithotripsy treatment with high efficiency and safety advantages,it is worth the promotion and application of clinical.